Assessment of the diagnostic performance of various screening tools for bipolar disorder: a meta-analysis

Abstract

Background: Various studies have shown that about 40–50% of patients with bipolar disorder (BD) are undiagnosed at the time of referral and are often treated as depression. The present meta-analysis was conducted to determine the diagnostic accuracy of psychometric properties of the bipolarity index (BI) in people with BD. Methods: We systematically searched databases including, Scopus, ISI Web of Sciences (WOS), Pubmed/Medline, Embase, and PsycINFO using standard search terms. Results: Two hundred and ninety-six records were found through the initial search. Of 679 articles, 25 duplicated studies were found and 70 were omitted due to the irrelevant titles and abstracts. The rest 450 were entered the full-text screening, of which 186 were excluded due to pre-defined inclusion criteria. Ultimately, 15 studies on 6525 patients were included. Our findings showed that the pooled sensitivity of BI in the diagnosis of BD was 0.82 (95%CI: 0.81–0.83, P < 0.0001, I2 = 99%), while the pooled specificity also was 0.73 (95%CI: 0.72–0.74, P = 0.000, I2 = 99%). The BI was significantly more accurate than the other tests with a pooled DOR of 47.2 (95%CI: 12.01–85.52, P = 0.0000, I2 = 99.2%). Conclusion: BI appears to be a useful screening instrument with suitable psychometric properties to identify BD compared to both the MDQ and the HCL-32. Consequently, patients detected by the BI should be confirmed through diagnostic interviews. Thus, more studies are needed to explore the optimal cut-off values of BI among screened populations during long-term follow-up, since a considerable portion of individuals primarily diagnosed with major depressive disorders could have BD.